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Packard starts offering surgery to reverse teen obesity

Without operation to help her lose weight, teenage girl was likely to suffer even more severe illnesses

By Katharine Miller

Amy Feldman

In Roux-en-Y gastric bypass surgery, a piece of the small intestine is connected to the small stomach pouch that surgeons have separated from the majority of the stomach.

Surgeons at Lucile Packard Children’s Hospital last week performed the first bariatric surgery at a California children’s hospital, signaling not only that morbidly obese teens in the state can now receive more appropriate care but also that more youths may become eligible for the procedure at younger ages.

Until now, adolescents who were considering bariatric surgery in California—an operation to reduce the size of the stomach—had to go to adult hospitals. But physicians at the hospital’s Center for Healthy Weight believed that this surgery of last resort should be available in a pediatric context.

“It’s paramount that adolescent specialists care for these children in kid-centric facilities,” said Craig Albanese, MD, the hospital’s chief of pediatric surgery and surgical director for its Center for Healthy Weight. “This is not a quick-fix operation. This is a tool that helps people achieve a more healthy lifestyle, and it requires an appropriate support system for the patient and the family.”

At age 18, Albanese’s patient weighs 270 pounds and has struggled with her weight since kindergarten. “I’ve been through every weight-loss program you can name,” she said. She suffers from headaches, blurred vision, knee problems and restricted breathing and is at risk of developing type-2 diabetes.

Her mother wants a healthy adulthood for her child. “I’ve been obese all my life,” she said. “I have tremendous health problems. I don’t want this life for her.”

The girl had surgery, called a Roux-en-Y gastric bypass, on Nov. 9, reducing her stomach to a pouch the size of a walnut. It was performed by Albanese and John Morton, MD, assistant professor of surgery and director of the medical center’s adult bariatric surgery program.

The surgery will only be done at the Packard Children’s Hospital for a limited number of patients who meet stringent criteria. “We’re only going to operate on the most severely ill of the severely obese adolescents,” Albanese said.

One-half to three-quarters of all obese adolescents will carry their obesity into adulthood, increasing their risks of developing serious or life-threatening conditions. Some obese adolescents already suffer from serious obesity-related illnesses. These teens may be eligible for bariatric surgery.

The bariatric program at the children’s hospital is one piece of its comprehensive program for healthy weight. Harvey Cohen, the hospital’s chief of staff and chair of the Department of Pediatrics, said, “We are committed to helping children and families deal with what we consider one of the biggest epidemics in pediatrics today—the epidemic of obesity.”

Before instituting an adolescent bariatric surgery program, the children’s hospital established clear guidelines for patient eligibility for the procedure.

Albanese co-authored a paper, published in the journal Pediatrics last July, outlining appropriate steps in deciding which severely obese adolescents would be good candidates for surgery.

At the children’s hospital, teens seeking bariatric surgery must have a body mass index (a defined relationship between a person’s height and weight) of more than 40 (healthy weight is defined as a BMI of 20 to 24).

The teen must also suffer from one of three obesity-related illnesses: type-2 diabetes, obstructive sleep apnea or pseudotumor cerebri, a condition in which pressure in the cranium causes headaches and vision problems.

Other requirements for bariatric surgery candidates at Packard are that they must have completed 90 percent of their growth; they must have a supportive family, and they must present objective evidence of a diet and exercise program that has failed. And they are required to show that they’ll adhere to strict dietary and exercise guidelines after the surgery.

“If they can’t do what we’re asking before surgery,” explained Albanese, “then they won’t succeed after.”